by K Carothers
“I know what kinds of wounds some of them can leave. And usually the bigger the gun, the bigger the wound. But I guess better aim beats a bigger gun.”
“Or just plain dumb luck.”
They were almost to the clearing, and Erin was glad. She was out of breath. Maybe it hadn’t been such a good idea to cancel her gym membership after all. She noticed Luke didn’t look the least bit winded.
“We’re pretty far from the hospital so we called in a medevac chopper,” he said. “And it’s a damn good thing, too, because the ambulance crew almost missed the party. They had some trouble with the coordinates and initially went too far north. But the chopper should be here shortly.”
They reached the field a moment later, and Erin saw there were police and rescue vehicles scattered everywhere. A number of them were parked a little farther down the field with their lights flashing, where she presumed they were setting up the helicopter landing zone. The ambulance was parked in an area to their right, and Luke quickly led her around it to the injured boy on the other side.
He was lying on a stretcher that had been lowered to the ground, with an oxygen mask covering his mouth and nose. Two paramedics, a male and a female, were attending to him. One was hooking him up to a monitor, while the other was trying to get an IV into his left arm.
Erin knelt down next to him, tucking her blond hair behind an ear as she assessed the situation.
“She’s a doctor,” Luke told the paramedics when they looked up.
“We didn’t hear any sucking sounds coming from the wound or see any air bubbles, and I heard breath sounds on the right,” the male paramedic said, squatting down near the end of the stretcher to finish setting up the monitor there. “But we put a chest seal on just in case. And there wasn’t an exit wound.”
Erin noted they’d cut away the boy’s T-shirt and placed the seal over the bullet wound lateral to his right nipple. The seal was made of a clear adhesive material with a plastic, one-way valve in the middle that kept air from getting sucked into the wound when he inhaled, but allowed any air that had already gotten inside to escape—that is, if clotted blood and damaged body tissues weren’t blocking the way out. But even with the wound covered, air could still leak out from any part of the lung injured by the bullet and accumulate in the space between the lung and the chest wall. If that air couldn’t get out through the valve, more and more of it would get trapped in there and push against the lung until it collapsed. Then, as the pressure increased further, the blood vessels to the heart would get squeezed shut. And if the air wasn’t released immediately at that point, the heart would stop.
The boy was breathing rapidly, and Erin saw panic in his brown eyes. He weakly tried to pull at the oxygen mask on his face and gasped, “I…I can’t…breathe…”
The female paramedic glanced up nervously. “I’m having trouble getting an IV in.”
“His blood pressure is 81 over 45,” the other paramedic said. “His pulse is in the 130s, and it looks like he’s in a regular rhythm. The best oxygen saturation I’m getting is 83 percent—wait, now it’s dropping into the 70s. I think we should intubate him.”
“I need your stethoscope,” Erin told him. She could see both paramedics were young and inexperienced.
He handed it to her, and she listened to the boy’s lungs. There were no longer any breath sounds on the right side. His lung had collapsed. Too much air was trapped inside.
She set the stethoscope down and felt his trachea. It was being pushed over to the left by the trapped air. And she saw his neck veins were bulging because the blood couldn’t get back to his heart. She checked for a pulse in his wrist. If his blood pressure was still above 80 she should be able to feel a pulse there. But there was no pulse. And his skin was becoming more bluish in color by the second. He was in serious trouble.
“I’m going to do a needle thoracentesis,” Erin told the paramedics. “Get me a needle—at least 14-gauge and 3 inches long, some gloves, and an alcohol pad—quickly!”
She looked up at Luke. “I have to put a needle into his chest to get the air out, and there’s no time to numb him up. Can you hold him still?”
Luke nodded, though his face visibly blanched as he knelt at the head of the stretcher.
Erin pulled on the gloves one of the paramedics handed her, then felt for the third rib on the right side, several inches below the middle of the boy's collarbone. She briefly swabbed the area just above it with the alcohol pad, keeping a finger there so she wouldn't lose her spot. And without hesitation, she grabbed the needle and plunged it into his chest.
The boy let out a moan and bucked with all the energy he had left, but Luke held him down.
Suddenly there was an audible whoosh when the needle hit the trapped air and released it. Erin was relieved to see no blood came out. That was a good sign.
The needle was surrounded by a thin plastic catheter tube, and she pushed the tube down all the way into his chest until only the hub was visible against his skin. Then she slid the needle out and held the tube in place with her fingers.
She felt for the pulse in the boy’s wrist again with her free hand. There it was, weak but palpable. And within seconds it got stronger, and stronger. A healthy pink color returned to his skin.
Luke glanced up at the sky. “The chopper’s coming.”
Erin squinted into the sun and watched as the big blue and white bird headed toward them. Then she shifted her gaze to meet Luke’s. Yes, there was definitely a perfect summer day in those eyes.
The boy groaned, and she turned her attention back to him. He wasn’t struggling to breathe anymore, but was in obvious pain, thanks to the two holes in his chest now. Better two holes there, she thought, than the one foot he’d had in the grave before. Another minute and that would have been two.
“I’ll need some tape to keep the catheter in place,” Erin told the male paramedic. “And if his blood pressure is at least 90 systolic you can give him 50 mics of fentanyl for pain.”
“Finally! I’ve got an IV in,” the other paramedic said, looking up in relief. The color returned to her face, too.
Erin nodded, checking the cardiac monitor. “His heart rate is better, and as long as his blood pressure is stable, don’t run fluids any faster than TKO. We don’t want to blow open any blood clots with too much fluid.”
While the paramedics carried out her instructions, she secured the catheter to the boy’s chest. She could feel Luke watching her the whole time, and it set off an odd fluttering in her own chest.
A moment later the helicopter made a slow descent onto the field. The characteristic whup-whup-whup of its main rotor got louder as it came down, and it kicked up dirt and debris everywhere.
Erin grabbed the stethoscope, her hair whipping in the wind created by the aircraft, and listened to the boy’s lungs again, covering one ear with her free hand to block out some of the noise behind her. She heard good air movement on the right side now.
She glanced back just as the helicopter was landing. “We’ve done as much as we can here!” she shouted to the paramedics. “Pull up the stretcher and get him to the helicopter!”
Luke jumped to his feet and reached down to help her up. Erin took his hand and instantly felt a rush of warmth flow through her. She tried to stand, but couldn’t seem to get her legs to work right, and stumbled backward instead.
Luke immediately hooked an arm around her waist and pulled her up against him. Their gazes locked, and for a second Erin forgot about the chaos around them. It was just her and him and the infinite blue of his eyes.
He gave her a brief smile, attractive laugh lines forming at the corners of those eyes. “Are you okay?”
She didn’t hear the question so much as she felt it, for some odd reason, and nodded in response.
Then the moment was broken. He let her go and turned to help the paramedics.
Erin stayed back, shaking off her embarrassment over acting like a total klutz in front of everyone—there was a good reason she’d never been in gymnastics—and watched as they rolled the boy toward the helicopter and quickly loaded him up. Within minutes the bird was flying again, and she marveled at the sight of it ascending into the cloudless blue sky. She’d never seen a helicopter take off or land, she realized. Plenty of helicopters came to Boston General, but she’d always been inside, waiting for the patient.
Luke jogged back over to her a few minutes later. “Do you think he’ll pull through?”
“I think so,” she said, ignoring the way his nearness stirred up those odd sensations inside her again. She was probably just feeling a little off-kilter because of what had happened with the boy. “There wasn’t a lot of bleeding, so I doubt the bullet hit any major blood vessels. He’s lucky.”
Luke stared down at her with admiration in his eyes. “He’s lucky you were here. That thing you did with the needle…” He shook his head. “I’ve never seen anything like it before. I just hope I’m never on the receiving end.”
Erin laughed shortly. “I hope I don’t have to do that again anytime soon. Are duels a common thing in New Dublin?”
Luke’s lips twisted into a grim smile. “Before today the last duel on this side of the Atlantic probably happened over a hundred years ago. And I doubt it was anywhere near New Dublin, Wisconsin. I sure hope this doesn’t become a trend.”
Erin glanced up at the sky. The helicopter was just a tiny speck in the distance now. “Are they taking him to Madison? I would imagine the hospital in New Dublin is too small to handle that kind of trauma.”
Luke remembered when Erin used to work at the hospital. He would go there sometimes under the pretense of visiting his dad, hoping to run into her. He’d been such an awkward teenager, though. If he did see her he would get so tongue-tied when he looked into those big green eyes that he would never be able to say two words. “Actually, they are going there,” he told her. “The hospital’s changed a lot over the years. They built a state-of-the-art surgery center, and my dad brought in a partner, Colin O’Reilly, who has experience in trauma. I think he came shortly after you left. He’s originally from New Dublin. His dad had a family practice clinic here for decades until he retired a few years ago.”
“Dr. Nolan O’Reilly—or Dr. O, as some of the staff liked to call him,” Erin said with a smile. “Even after all these years he still sends me a card every Christmas and on my birthday.”
Dr. O’Reilly had always been her idol. He was the smartest man she’d ever met, yet he had such a jovial personality, and his enthusiasm for life and medicine was infectious. The energy level immediately went up when he walked into a room. He would talk to anyone, and treated everyone with equal respect, whether it was Dr. Mathis, the chief of staff, or the cleaning crew. When Erin had shown an interest in pursuing medicine herself, Dr. O’Reilly took her under his wing. They’d had endless conversations on the subject, with him usually doing most of the talking. She would stay late at the hospital almost every shift, unpaid, to spend more time with him rather than going back to her grandparents’ house. And he hadn’t had anyone to go home to, either. One of the nurses told her that his wife had died from a massive pulmonary embolism while she was pregnant, causing the deaths of their unborn twin daughters as well. He’d never remarried, and his son, Colin, moved to Madison after high school to attend college and get a medical degree of his own. It was Dr. O’Reilly who’d written her first letter of recommendation to Harvard.
“How is Dr. O’Reilly doing?” Erin asked.
Luke chuckled. “He’s energetic as ever. And as much as he complains about retirement, I think he’s enjoying it. He likes to hang out at the Corner Café with all the other old timers in town and brag about his Irish ancestors.”
Erin grinned at that. “I always thought he liked me because of my name. I told him I didn’t have any Irish blood that I knew of, but he said I still had an Irish soul. Every time he saw me he used to say, ‘Erin go bragh.’ It’s an Irish phrase that means Ireland forever.”
As she spoke, the two paramedics walked up to them. “Should we take the other boy, Detective Mathis?” the female paramedic asked, her cheeks flaming crimson when she looked at Luke.
“It’ll be easier for us to get him to the ER,” Luke said. “It’s only a minor wound.”
The girl turned to Erin. “Thank you so much for your help. We’ve practiced putting a needle in like that, but I’ve never actually done it—or even seen it done on a real person before. You were amazing.”
Erin shrugged off the compliment, uncomfortable as always with such praise. “I just did what I needed to do. And now that you have seen it done, you’ll be ready to do it yourself next time.” She glanced down at the girl’s name badge. Amy Duncan. “And another thing, Amy, do you have an intraosseous drill in your ambulance?”
“Yes, we have one,” Amy answered with a wince. “I know I should probably have used it when I couldn’t get an IV in the first few times.”
Seeing her distressed expression, Erin smiled encouragingly. “Now you know that, too. And it wouldn’t be unreasonable to use the IO drill right away if you’ve got a critical patient. Then you won’t have to fiddle around with a peripheral IV when you need to get a line in fast.”
“Yes, I’ll remember that,” Amy said. “Thank you again. And you too, Detective Mathis.” She glanced at Luke before turning away, and another bright red blush stained her cheeks.
Erin’s lips quirked up in amusement as she watched Amy leave with the other paramedic. “It looks like someone has a crush on you.”
Luke laughed softly. “I like women, not girls.”
Erin felt those strange, fluttering sensations start in her chest again, and she quickly changed the subject. “Do you want me to take a look at the other kid before you go?”
“Sure, if you don’t mind. His name is Connor Murdock. He’s the mayor’s son.” Luke motioned to two men standing near a sheriff’s SUV and led her over to them. “Pete Thompson, one of the sheriff’s deputies, has Connor in his vehicle. He and Scott Ripley were interviewing him. Scott’s another detective on the force and a good friend of mine.” A half-smile briefly crossed Luke’s face. “He’s the big, mean-looking guy in the Coldplay T-shirt. Obviously our dress code is a little lax.”
Luke formally introduced her to the pair, and Pete opened the rear passenger door of the SUV.
Connor sat in the backseat with his hands cuffed behind him and tears streaming down his cheeks.
“Come on out, Connor,” Luke said, helping him up. “Dr. Harris is going to look at your arm.”
Erin opened her mouth to correct Luke about using her maiden name, but then closed it again. Suddenly it didn’t seem that important.
“Is Jesse dead?” Connor asked, his voice trembling. “I wasn’t really going to shoot him, I swear. The gun went off by accident when I turned around. I swear.”
“Jesse’s alive, and you can thank Dr. Harris for that,” Luke told him. “She saved you from a murder charge, son.”
Connor thanked Erin profusely, over and over, in the same ragged, anguished tone, and she soon had to look away, dropping her gaze to his bandaged left upper arm. He may have shot someone, but she still found that kind of pain difficult to witness.
She gently unwrapped the makeshift bandage and inspected the wound. Luke was right, it wasn’t bad. Connor had a jagged cut on the outside of the arm where the bullet had grazed him as it went past. But it wasn’t too deep, and there hadn’t been much bleeding. A few inches over, though, and he would have been as bad off as the other boy— or worse. She didn’t want to contemplate that scenario.
“He’ll need a few stitches,” she said, replacing the bandage. “Otherwise everything looks okay.”
Luke nodded and turned to Scott. “Pete can take him to the ER. In the mea
ntime, call Mayor Murdock and get him over there ASAP, and make sure one of our guys stays with the other kid. I’ll work with the sheriff’s deputies here and meet up with you in a little while.”
“Sure thing, Luke,” Scott said, glancing curiously at Erin before he headed to his own vehicle.
Luke sighed, rubbing a hand over his clean-shaven jaw. “We’ve got one hell of a mess to sort out. The Sheriff’s Office has jurisdiction out here, but we offered mutual aid. The problem is, the sheriff, her chief deputy, and our police chief are all at a conference in Madison right now, and our assistant chief is on vacation in Mexico. Lucky me.” He smiled wryly. “I’ll give you a ride back to your car. I won’t make you run this time.”
Erin laughed. “I probably should. That little jaunt through the woods made me realize how much I need to start working out again.”
Luke lowered his gaze to her body, clad in a T-shirt and jeans. “It looks to me like whatever you’re doing is working out just fine.” She was exactly as he remembered her, slightly above average in height, with curves in all the right places.
Erin felt her skin tingle wherever his gaze traveled. And when he looked back up at her there was an intensity in those blue eyes that made her knees weak and scattered every thought in her head. She was at a loss for words. She couldn’t think. She couldn’t move. So she just stood there like a deer in the headlights.
“I guess we’d better get going,” Luke finally said. And much to her relief, he turned away, leading her over to his unmarked blue sedan.
He opened the passenger door for her, and she thanked him with a tentative smile before sliding in, though she couldn’t quite meet his gaze after the foolish way she’d just acted—yet again. She wasn’t any better than that twenty-year-old paramedic.
But almost as soon as he closed the door an entirely different sort of tension filled her—a tension she knew all too well. She felt her heart pick up speed. A deep sense of dread came over her, and she wanted to jump out of the car and run. She had no idea what would have triggered such intense anxiety in Luke’s car, though, and hesitantly glanced around the interior, trying to reassure herself that she had nothing to be afraid of. It looked like a typical police car, or at least what she would expect one to look like. There was the radio, and a computer mounted above it next to the steering wheel. And behind the driver’s seat was a rifle.
